The effect of chronic liver disease on acute outcomes following cervical spine trauma

Background context: The adverse impact of chronic liver diseases, including chronic hepatitis and cirrhosis, on outcomes following orthopedic surgery has been increasingly recognized in recent years. The impact of these conditions on acute outcomes following spinal trauma remains unknown.

Study design: This is a cohort control study that uses patient records in the Massachusetts Statewide Inpatient Dataset (2003-2010).

Purpose: The study aimed to evaluate whether chronic liver disease increased the odds of mortality, complications, failure to rescue (FTR), reoperation, and hospital length of stay (LOS) following cervical spine trauma.

Patient sample: The sample is composed of 10,841 patients with cervical spine trauma.

Outcome measures: Posttreatment morbidity, mortality, reoperation, and LOS were the outcome measures.

Methods: Differences between patients with and without chronic liver disease were evaluated using chi-square or Wilcoxon rank-sum tests. Logistic and negative binomial regression techniques were used to adjust for confounders, including whether a surgical intervention was performed. Receiver operator characteristic curves were used to assess final model discrimination.

Results: There were 117 patients with chronic liver disease identified in the cohort. The rate of surgical intervention for cervical trauma was not significantly different between patients with and without chronic liver disease (odds ratio [OR]: 0.82, 95% confidence interval [CI]: 0.52-1.29). Mortality (OR: 2.12, 95% CI: 1.23-3.66), FTR (OR: 2.86, 95% CI: 1.34-6.11), complications (OR: 1.65, 95% CI: 1.12-2.45), and LOS (regression coefficients: 0.31, 95% CI: 0.14-0.48) were all significantly increased for patients with chronic liver disease in final adjusted models that controlled for differences in case-mix and whether a surgical procedure was performed. Final models explained approximately 72% of the variation in mortality and FTR.

Conclusions: Our novel findings indicate that patients with chronic liver disease may be at elevated risk of posttreatment morbidity and mortality following cervical spine trauma. Medical comanagement in the acute period following injury and optimization before surgery may diminish the potential for adverse events.